210 Transactions of the Society. 



the effective nutrition of these tissues, whose function and activity 

 are correspondingly lowered. They are now unable to do their 

 work properly, to retain the fluids within proper bounds to 

 help in their circulation. Unless the causes'! are removed or the 

 condition becomes gradually worse, until the lowering of vitality 

 and function become so great that the evidence of their presence 

 becomes marked. If the limbs are subjected to a low temperature, 

 especially for a long period, the impairment becomes more evident ; 

 they become swollen and dropsical, a condition in which the 

 uerves participate, and these latter, deprived of much of their 

 nutrient supply, become functionally inert, though when this supply 

 is being restored they may become so stimulated that intense pain 

 may result. 



In the trenches, as pointed out by Col. Griffiths, there is the ad- 

 ditional factor of the water, which may exert some direct pressure 

 upon the tissues of the lower limbs from without and so interfere 

 with nutrition. This factor assumes still greater importance as 

 the clothing, and especially boots, stockings and putties, when 

 wetted tend to shrink, all this favouring the condition of "pressure 

 starvation." 



Such a condition is seen in miniature in the numbness followed 

 by " pins and needles " in a limb from which the blood-supply is 

 cut off temporarily. The numbness occurs because of the cutting 

 off of the blood-supply to the nerves, say when we sit in a cramped 

 position for some time, the "pins and needles" coming on as the 

 blood-supply — nutrition — is restored. 



The nerves, or other tissues, deprived of their full nutriment 

 for a prolonged period may lose their function and become more or 

 less permanently altered in structure, and the alteration ma}' be so 

 grave that only prolonged treatment, and, one might say, repair of 

 the structures, can restore their function. There are cases, of course, 

 in which the tissues are rapidly destroyed partly as the result of 

 lowered temperature and partly, often, as the result of too sudden 

 and too marked reaction — inflammation — of the tissues, but the 

 majority of the cases of so-called frostbite appear to be, not in- 

 flammatory, but the result of impaired vascular and lymphatic 

 circulation followed by malnutrition, more or less marked of all 

 the tissues of the lower limbs, and oedema or dropsy of the delicate 

 tissue supporting the nerve fibrils, and leading to a loss of nerve 

 function, and even alteration in structure. 



The men standing in the trenches suffer as does the horse 

 standing in his stall. The treatment for the condition in the horse 

 is regular and graduated exercise, and for that in the soldier the 

 same, in" the very early stages, and in the more advanced stages 

 protection of the weakened tissues from extremes of both heat and 

 cold, from injury and from irritation, in order that there may be as 

 little inflammatory reaction as possible. The patient should be 



